Rotator Cuff Repair: An Ex Vivo Analysis of Suture Anchor Repair Techniques on Initial Load to Failure

Background Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair. Purpose To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques. Hypothesis Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to single-row repair. Study Design Controlled laboratory study. Methods Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. Results There were no differences in load to failure and displacement with cyclic loading between the single-row repair and each double-row repair. All repair groups demonstrated load to failure greater than 250 N. A significantly greater supraspinatus footprint width was seen with double-row techniques compared to single-row repair. Conclusions The single-row repair technique was similar to the double-row techniques in load to failure, cyclic displacement, and gap formation. The double-row anchor repairs consistently restored a larger footprint than did the single-row method. Clinical Relevance The arthroscopic techniques studied have strong structural properties that approached the reported performance of open repair techniques. Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.

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Tendon-to-Bone Pressure Distributions at a Repaired Rotator Cuff Footprint Using Transosseous Suture and Suture Anchor Fixation Techniques

The American Journal of Sports Medicine ◽

10.1177/0363546504273053 ◽

2005 ◽

Vol 33 (8) ◽

pp. 1154-1159 ◽

Cited By ~ 161

Author(s):

Maxwell C. Park ◽

Edwin R. Cadet ◽

William N. Levine ◽

Louis U. Bigliani ◽

Christopher S. Ahmad

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Suture Anchor ◽

Rotator Cuff Tears ◽

Interface Pressure ◽

Repair Technique ◽

Pressure Distributions ◽

The Mean ◽

Cuff Repair ◽

Repair Techniques

Background Interface contact pressure between the tendon and bone has been shown to influence healing. This study evaluates the interface pressure of the rotator cuff tendon to the greater tuberosity for different rotator cuff repair techniques. Hypothesis The transosseous tunnel rotator cuff repair technique provides larger pressure distributions over a defined insertion footprint than do suture anchor techniques. Study Design Controlled laboratory study. Methods Simulated rotator cuff tears over a 1 × 2-cm infraspinatus insertion footprint were created in 25 bovine shoulders. A transosseous tunnel simple suture technique (n = 8), suture anchor simple technique (n = 9), and suture anchor mattress technique (n = 8) were used for repair. Pressurized contact areas and mean pressures of the repaired tendon against the tuberosity were determined using pressure-sensitive film placed between the tendon and the tuberosity. Results The mean contact area between the tendon and tuberosity insertion footprint was significantly greater for the transosseous technique (67.7 ± 5.8 mm2) compared with the suture anchor simple (34.1 ± 9.4 mm2) and suture anchor mattress (26.0 ±5.3 mm2) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was also greater for the transosseous technique (0.32 ± 0.05 MPa) compared with the suture anchor simple (0.26 ± 0.04 MPa) and suture anchor mattress (0.24 ± 0.02 MPa) techniques (P < .05). Conclusion The transosseous tunnel rotator cuff repair technique creates significantly more contact and greater overall pressure distribution over a defined footprint when compared with suture anchor techniques. Clinical Relevance Stronger and faster rotator cuff healing may be expected when beneficial pressure distributions exist between the repaired rotator cuff and its insertion footprint. Tendon-to-tuberosity pressure and contact characteristics should be considered in the development of improved open and arthroscopic rotator cuff repair techniques.

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Tendon-Bone Interface Motion in Transosseous Suture and Suture Anchor Rotator Cuff Repair Techniques

The American Journal of Sports Medicine ◽

10.1177/0363546505278252 ◽

2005 ◽

Vol 33 (11) ◽

pp. 1667-1671 ◽

Cited By ~ 101

Author(s):

Christopher S. Ahmad ◽

Andrew M. Stewart ◽

Rolando Izquierdo ◽

Louis U. Bigliani

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Suture Anchor ◽

Suture Repair ◽

Interface Motion ◽

Bone Interface ◽

Transosseous Suture ◽

Supraspinatus Tear ◽

Cuff Repair ◽

Suture Anchor Repair

Background Although many studies involving rotator cuff repair fixation have focused on ultimate fixation strength and ability to restore the tendon's native footprint, no studies have characterized the stability of the repair with regard to motion between the tendon and repair site footprint. Hypothesis Suture anchor fixation for rotator cuff repair has greater interface motion between tendon and bone than does transosseous suture fixation. Study Design Controlled laboratory study. Methods Twelve fresh-frozen human cadaveric shoulders were tested in a custom device to position the shoulder in internal and external rotations with simulated supraspinatus muscle loading. Tendon motion relative to the insertional footprint on the greater tuberosity was determined optically using a digital camera rigidly connected to the humerus, with the humerus positioned at 60° of internal rotation and 60° of external rotation. Testing was performed for the intact tendon, a complete supraspinatus tear, a suture anchor repair, and a transosseous tunnel repair. Results Difference in tendon-bone interface motion when compared with the intact tendon was 7.14 ± 3.72 mm for the torn rotator cuff condition, 2.35 ± 1.26 mm for the suture anchor repair, and 0.02 ± 1.18 mm for the transosseous suture repair. The transosseous suture repair demonstrated significantly less motion when compared with the torn rotator cuff and suture anchor repair conditions (P <. 05). Conclusion Transosseous suture repair compared with suture anchor repair demonstrated superior tendon fixation with reduced motion at the tendon-to-tuberosity interface. Clinical Relevance Development of new fixation techniques for arthroscopic and open rotator cuff repairs should attempt to minimize interface motion of the tendon relative to the tuberosity.

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Arthroscopic Single-Row Versus Double-Row Suture Anchor Rotator Cuff Repair

Yearbook of Hand and Upper Limb Surgery ◽

10.1016/s1551-7977(08)70223-1 ◽

2007 ◽

Vol 2007 ◽

pp. 30-31 ◽

Cited By ~ 1

Author(s):

R.J. Goitz

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Suture Anchor ◽

Double Row ◽

Single Row ◽

Cuff Repair

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Supplementation of Rotator Cuff Repair with a Bioresorbable Scaffold

The American Journal of Sports Medicine ◽

10.1177/03635465020300031701 ◽

2002 ◽

Vol 30 (3) ◽

pp. 410-413 ◽

Cited By ~ 59

Author(s):

Jason L. Koh ◽

Zoltan Szomor ◽

George A. C. Murrell ◽

Russell F. Warren

Keyword(s):

Rotator Cuff ◽

Ultimate Strength ◽

Rotator Cuff Repair ◽

Suture Anchor ◽

Testing Machine ◽

Poly Lactic Acid ◽

Bone Bridge ◽

Initial Strength ◽

Bridge Model ◽

Cuff Repair

Background Repair of a torn rotator cuff should have sufficient initial strength of the fixation to permit appropriate rehabilitation. Hypothesis Augmentation with a woven polylactic acid scaffold strengthens repairs of the rotator cuff. Study Design Controlled laboratory study. Methods In the suture-anchor model, 10 pairs of sheep infraspinatus tendons were detached and repaired to suture anchors. In half of the matched specimens, the repair was reinforced with a woven poly-lactic acid scaffold repaired with the tendon to bone. In the bone-bridge model, sutures were passed through a trough and over a bone bridge distal to the greater tuberosity; half were reinforced by the scaffold. The repairs were tested to failure with a hydraulic testing machine. Results The mean ultimate strength of suture-anchor repairs augmented with the scaffold (167.3 ± 53.9 N) was significantly greater than that of nonaugmented fixation (133.2 ± 38.2 N). Failure occurred when the tendon pulled through the sutures; the scaffold remained intact. Scaffold reinforcement of the bone bridge significantly increased the ultimate strength from 374.6 ± 117.6 N to 480.9 ± 89.2 N, and the scaffold remained intact in 8 of 10 specimens. Conclusions The scaffold significantly increased the initial strength of rotator cuff repair by approximately 25%.

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